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NPI Code Detail

MEDICARE: MARTHA BLODGETT

MEDICARE: MARTHA BLODGETT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOTR2900AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073973293
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA BLODGETT
Provider Business Mailing Address
First Line : PO BOX 333
Second Line :
City : WARD
State : AR
Zip : 72176-0333
Country : US
Telephone Number : 501-588-3211
Fax Number : 501-353-2599
Provider Business Practice Location Address
First Line : 5532 JFK BLVD
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72116-6708
Country : US
Telephone Number : 501-588-3211
Fax Number : 501-353-2599
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2016
Last Update Date : 02/21/2019

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Directions to “ MARTHA BLODGETT ” Practice Location

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